Where Is "Home"? Value Conflicts, Identity Crises and the Formation of Cosmopolitan Identity in Myanmar Students Studying in the United States

Fully engaging in a new culture means translating oneself into a different set of cultural values, and many of the values can be foreign to the individual. The individual may face conflicting tensions between the psychological need to be a part of the new society and feelings of guilt or betrayal towards the former society, culture or self. Many international students from Myanmar, most of whom have little international experience, undergo this value and cultural translation during their time in American colleges. It is commonly assumed that something will be lost in the process of translation and that the students become more Westernized or never fit into both Myanmar and US cultures. However, the study of the narratives of the Myanmar students studying in the US reveals a more complex reality. Because individuals have multifaceted identities and many cultures and subcultures are fluctuating and intertwined with one another, the students¿ cross-cultural interactions can also help them acquire new ways of seeing things. Through their struggle to engage in the US college culture, many students display the theory of ¿cosmopolitanism¿ in their transformative identity formation process and thus, define and identify themselves beyond one set of cultural norms.

A Job Diagnostic Survey of Nursing Home Caregivers: Implications of Job Redesign

Nursing home caregiving was analyzed as a job, subject to management intervention. Specifically examined was the usefulness of job redesign, a managerial intervention used to enhance worker motivation and effectiveness. Information from interviews with administrators was combined with survey data from aides and LPNs (n= 489) in 21 nursing homes to assess to need for, and feasibility of, redesign of caregiving work. Implementation principles and examples are included.

The Relationship of Antipsychotic Drug Use, Resident Behavior, and Diagnoses Among Nursing Home Residents

Nursing homes have been criticized for frequent use and possible misuse of psycho-active agents. These issues are of clinical concern and policy relevance, especially since the passage of the Omnibus Budget Reconciliation Act (OBRA) of 1987. Using a sample of 419 residents, the authors examined the relationships among antipsychotic drug (AP) use, behavior, and mental health diagnoses. Only 23.2% of the residents were administered APs on a routine and/or "as-needed" basis. Based on the Multidimensional Observation Scale for Elderly Subjects (MOSES) ratings, AP users were more irritable, disoriented, and withdrawn than were nonusers. Also, AP users demonstrated agitated behaviors more frequently. Notably, AP users and nonusers differed significantly in terms of documented mental health diagnoses. Among AP users, 70.1% had documented dementia, 8.3% were psychotic or had other psychiatric disorders, and 21.6% had no mental health diagnoses. In contrast, the majority of nonusers had no mental health disorders. Logistic regression revealed that diagnostic factors, frequency of agitation, level of withdrawal, and marital status were significant predictors of AP use.

Improving Nursing Home Care Through Training amd Job Redesign

Nursing assistants have the primary contact with older residents of nursing homes. The Penn State Nursing Home Intervention Project's short-term longitudinal study assessed the single and combined effects of two interventions designed to affect nursing assistants' performance by increasing their knowledge and motivation: skills training and job redesign. Statistically significant differences in nursing assistants' knowledge were evident in comparisons between intervention and control sites, but performance was not improved. Implications for policy, practice, and research are discussed.

The Psychosocial Quality of Nursing Home Work

Trained observers used components of the functional job analysis technique to categorize 3,371 tasks performed by 214 nursing assistants in four nursing homes on five occasions over 12 months. The extent to which each task was oriented toward residents versus data or things was coded along with the "level of complexity" of each of these orientations. A psychosocial index was created by multiplying orientation by complexity. Three questions structured the analyses: (a) To what extent do nursing assistants' tasks involve interacting with residents, as opposed to focusing on data or manipulating things? (b) How complex are these tasks? (c) What are the implications of the task analysis data for assessing the quality of psychosocial care? Findings reveal that even among the direct care tasks (69% of total), the orientation was not predominantly toward the resident. Functional complexity of the tasks observed was consistently low. Those task types with the greatest psychosocial quality were those performed least frequently and vice versa. Implications of these results for restructuring nursing assistants' work are discussed.

Nursing Home Aides' Work and Family Connections

In order to maintain a productive workforce, organizations must acknowledge that many employees, particularly nurse aides, perform full-time care giving, both on and off the job. Competing demands between work and family can affect job performance, quality of care and bring on burnout.

Mental Health Services for Nursing Home Residents: What Will It Cost?

The Nursing Home Reform Act of 1987 requires nursing homes to provide basic mental health services for all residents and to give active mental health treatment, a set of specialized mental health services, to those residents who are admitted with a serious mental illness. This article examines the potential size of the nursing home population who will require mental health services, its demographic composition, and the facilities in which these individuals reside using the Institutional Population Component of the National Medical Expenditure Survey. Estimates of the potential costs of providing monthly psychotherapy and pharmacological management to this population in nursing homes indicate that the mandate will have significant financial effects on nursing facilities. Conclusions about how the requirements for maintaining the mental and psychosocial well-being of nursing home residents may affect the future of nursing home care and mental health care are considered.

Determinants of the Use of Specialist Mental Health Services by Nursing Home Residents

This study examines the effects of resident and facility characteristics on the probability of nursing home residents receiving treatment by mental health professionals.

Decision-Making Incapacity Among Nursing Home Residents: Results From the 1987 NMES Survey.

Recent legislative and regulatory developments have focused attention on older adults' capacity for involvement in health care decision-making. The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) focused attention on the rights of nursing home residents to be involved in health care decision-making to the fullest extent possible. This article uses data from the 1987 National Medical Expenditure Survey (NMES) to examine rates of incapacity for health care decision-making among nursing home residents. Elements of the Oklahoma statute were used to operationalize decision-making incapacity: disability or disorder, difficulty in decision-making or communicating decisions, and functional disability. Fifty-three percent of nursing home residents had a combination of either physical or mental impairment and an impairment in either self-care or money management. The discussion focuses on the policy and practice implications of significant rates of incapacity among nursing home residents.

Accuracy of Recognition and Diagnosis of Comorbid Depression in the Nursing Home

A variety of research has documented high levels of depression among older adults in the health care setting. Additional research has shown that care providers in health care settings are not very effective at diagnosing comorbid depression.This is a troublesome finding since comorbid depression has been linked to a number of negative outcomes in older adults. Early results have indicated that comorbid depression may be associated with a number of unfavorable consequences ranging from impairments in physical functioning to increased mortality.The health care setting with arguably the highest rate of physical impairment is the nursing home and it is the nursing home where the effects of comorbid depression may be most costly. Therefore, the current analysis uses data from the Institutional Population Component of the NationalMedical Expenditure Survey (US Department of Health and Human Services, 1990) to explore rates of both recognized and unrecognized comorbid depression in the nursing home setting. Using a constructed proxy variable representative of the DSM-III-R diagnosis of depression, results indicate that approximately 8.1% of nursing home residents have an unrecognized potential comorbid depression.

Risk Factors for Physical Restraint Use in Nursing Homes: The Impact of the Nursing Home Reform Act

This study examined the impact of the Nursing Home Reform Act of 1987 on resident-and-facility-level risk factors for physical restraint use in nursing homes. Data on the 1990 and 1993 cohorts were obtained from 268 facilities in 10 states, and data on a 1996 cohort were obtained from the Medical Expenditure Panel Survey, which sampled more than 800 nursing homes nationwide. Multivariate logistic regression models were generated for each cohort to identify the impact of resident- and facility-level risk factors for restraint use. The results indicate that the use of physical restraints continues to decline. Thirty-six percent of the 1990 cohort, 26 percent of the 1993 cohort, and 17 percent of the 1996 cohort were physically restrained. Although there was a reduced rate of restraint use from 1990 to 1996, similar resident-level factors but different facility-level factors were associated with restraint use at different points in time.